After an extensive search, Mary had gotten a new full-time job that started a month ago. She was transitioning from out of state and was looking forward to starting over in a new place. She thought that Waco would be more her speed after living in Chicago for the last 20 years. We've seen a lot of people relocating like Mary over the last five years.
Now that she had her job and could breathe a little easier because she wasn't using her savings to live on, she was also excited that this new job came with a health care plan for her. She began looking at the plan details and tracking down in-network healthcare providers to see. She also decided to make sure that she understood her copays, deductibles, and other out of pocket costs. As she did this, she started to become frustrated as it appeared that her options for approved health insurance providers were limited and those out of pocket health costs were going to be pretty steep. Especially when you consider the annual premiums that you are being taken out of your paychecks.
Have you ever been in Mary's shoes and wondered what you're actually paying for with your health insurance? Deductibles, copays, coinsurance, max out of pocket, prescription tiers, pre-authorizations...it's enough to make your head spin! And it seems like every time you look, less is covered but the prices keep going up! Whether you have employer-sponsored insurance or an individual plan, it's all just a big confusing mess that only benefits the insurance companies. Even the doctors can't stand it!
Texans face a strange world of health insurance and employer plans. The belief that good health insurance only comes from employers is widespread. But when policies sound like jumbled fortune cookies in a foreign language, people start questioning their options. So, what do you do if your work health insurance sucks? Mary reached out to us to find if there were any affordable health plan options that she could leverage.
We have a couple of times a year where our health agents become busy helping Texans like Mary evaluate their options for affordable health insurance because of what they are seeing in their annual employer health benefits enrollment. One of those time periods is when the teachers go back to school and the other is during the fourth quarter of every year when it seems like almost every company goes through their open enrollment for benefits. With that process comes the news about what is being done to the health insurance plan to "keep the costs of health care down".
At that point, the documents stating premiums and deductibles come rolling through and you feel confused about your coverage options just like Mary. We have good news. There is a path to comparing health insurance coverage beyond the health insurance premiums. It is important to understand networks and the true cost of health care for your family. Let's look at a plan to see how your level of coverage might stack up against your other options for health care coverage.
What are your guaranteed medical expenses for the year with each plan?
What could be you out in Medical Costs if you had a major health event?
The first step is to determine your guaranteed costs. This was an easy step for Mary, but we cannot stop there. You have more money at risk than just your guaranteed costs. This is where many Texans mess up their calculation. After you have determined your guaranteed costs and add up what you could be your out of pocket costs if you need to utilize your healthcare plan for more than basic guaranteed costs. This extra utilization could come from an ER visit, a referral to a specialist, or even a major surgery.
The total of guaranteed costs and potential costs when using your plan is your total cost of risk for any insurance plan or alternative to health insurance like health share programs. Take that total for each plan and see what your range of commitment is for each plan that you are evaluating. This will allow you to see not only the recurring, regular costs. But you will also see the downside potential if a major event were to happen on that health insurance coverage.
Knowing both the guaranteed costs to expect and the potential that you can be out of pocket will quickly expose if your employer-sponsored health insurance plan actually sucks because you can compare it to other plans available to all Texans including the individual health insurance exchange. This kind of comparison is more important than just comparing monthly premiums. Mary had never seen this before, but she liked understanding these differences and felt like she had power in the decision making now.
If you compare your current work plan to even the policies on the Affordable Care Act Exchange and determine that you can do better, what do you do now? The great news for you is that there are options in Texas that allow you to take control of your health care and the insurance that most feel is necessary to be protected from bankruptcy. When people like Mary call our office, they always want to know what their options are beyond the exchange and work plans. So let's take a look at what those are for Texans.
Mary liked having options and a plan to evaluate them. Choosing an alternative path to affordable coverage is a very subjective discussion which Mary was now beginning to understand. If you have a dreaded pre-existing condition it will reduce what type of health insurance options are available to you. But keep in mind that not all conditions are knock outs from coverage, so speak with an independent insurance agent who actually can sell you those kinds of policies.
The big reason that we believe that better health insurance is a subjective decision is that not all out of pocket health insurance costs are the same. We have seen local Texans utilize Direct Primary Care Doctors to manage all of their routine medical services in a very cost effective fashion. That concept pairs extremely well with a Catastrophic Health Insurance plan for a very cost effective solution when compared to marketplace coverage, traditional health insurance or even employer-sponsored plans.
On the converse of that, Short Term Plans have enough flexibility today to provide you a more traditional copay type situation. And there is always that Traditional Individual Health Insurance plan as well. The important thing to keep in mind are coverage gaps may be more important than just lowering your monthly costs.
We recommend working with a health insurance agent who can present multiple options to you. Having options allows for the agent to work as a fiduciary on your behalf. They can present both the positives and negatives without an agenda to make sure that you can make the best decision for you and your family. As independent insurance agents, Insurance For Texans functions in this kind of role. If you would like to explore your options, just click the button below to see what is available to you.